A lived experience co-designed study protocol for a randomised control trial: the Attempted Suicide Short Intervention Program (ASSIP) or Brief Cognitive Behavioural Therapy as additional interventions after a suicide attempt compared to a standard Suicide Prevention Pathway (SPP)

BACKGROUND: Despite being preventable, suicide is a leading cause of death and a major global public health problem. For every death by suicide, many more suicide attempts are undertaken, and this presents as a critical risk factor for suicide. Currently, there are limited treatment options with limited underpinning research for those who present to emergency departments with suicidal behaviour. The aim of this study is to assess if adding one of two structured suicide-specific psychological interventions (Attempted Suicide Short Intervention Program [ASSIP] or Brief Cognitive Behavioural Therapy [CBT] for Suicide Prevention) to a standardised clinical care approach (Suicide Prevention Pathway [SPP]) improves the outcomes for consumers presenting to a Mental Health Service with a suicide attempt. METHODS: This is a randomised controlled trial with blinding of those assessing the outcomes. People who attempt suicide or experience suicidality after a suicide attempt, present to the Gold Coast Mental Health and Specialist Services, are placed on the Suicide Prevention Pathway (SPP), and meet the eligibility criteria, are offered the opportunity to participate. A total of 411 participants will be recruited for the study, with 137 allocated to each cohort (participants are randomised to SPP, ASSIP + SPP, or CBT + SPP). The primary outcomes of this study are re-presentation to hospitals with suicide attempts. Presentations with suicidal ideation will also be examined (in a descriptive analysis) to ascertain whether a rise in suicidal ideation is commensurate with a fall in suicide attempts (which might indicate an increase in help-seeking behaviours). Death by suicide rates will also be examined to ensure that representations with a suicide attempt are not due to participants dying, but due to a potential improvement in mental health. For participants without a subsequent suicide attempt, the total number of days from enrolment to the last assessment (24 months) will be calculated. Self-reported levels of suicidality, depression, anxiety, stress, resilience, problem-solving skills, and self- and therapist-reported level of therapeutic engagement are also being examined. Psychometric data are collected at baseline, end of interventions, and 6,12, and 24 months. DISCUSSION: This project will move both ASSIP and Brief CBT from efficacy to effectiveness research, with clear aims of assessing the addition of two structured psychological interventions to treatment as usual, providing a cost-benefit analysis of the interventions, thus delivering outcomes providing a clear pathway for rapid translation of successful interventions. TRIALS REGISTRATION: ClinicalTrials.govNCT04072666. Registered on 28 August 201

Links between Childhood Experiences and Avoidant Personality Disorder Symptomatology

Research indicates that some types of adverse childhood experience may be involved in the development of avoidant personality disorder (AVPD). The current study examined relationships between retrospectively reported childhood maltreatment, parental bonding, and teasing on levels of adult AVPD symptomatology. The current study incorporated a cross-section research design. Four hundred and eleven, non-clinical participants (99 males and 312 females), ranging in age from 18 to 65 years (M= 29.75 years, SD= 11.44 years), completed a survey measuring current depression, anxiety and AVPD symptoms, and retrospective reports of childhood maltreatment, parental bonding and teasing. Consistent with hypotheses, AVPD symptomatology correlated positively with depression and anxiety symptoms, childhood maltreatment, parental overprotection and childhood teasing; while a negative association was found with AVPD and parental care. In regression, after controlling for the influence of depression and anxiety, sexual abuse and social behaviour teasing significantly and uniquely predicted AVPD symptomatology. Contrary to expectations, parental bonding was not a unique predictor of AVPD symptomatology in regression modelling. This study contributes to the understanding of factors potentially influencing the development of AVPD

The Western Airborne Contaminant Assessment Project (WACAP): An Interdisciplinary Evaluation of the Impacts of Airborne Contaminants in Western US National Parks.

The National Park Service Organic Act of 1916 (1) required protection of the national parks for perpetuity by tasking the National Park Service (NPS) to maintain these lands “...unimpaired for the enjoyment of future generations.” Near the close of the last century, the NPS became aware of a new body of research describing a potential ecosystem threat that could not be ignored. Toxic airborne contaminants were increasingly being found in the world’s most pristine alpine and polar ecosystems, far from where such chemicals were produced or used, and the risks to the national parks of the western U.S. were unknown. Airborne contaminants present a broad range of potential risks to these ecosystems, largely due to bioaccumulation and or biomagnification of toxicants in biota, particularly vertebrates, that can result in loss of fecundity, unfit offspring, maladaptive behavior, and even death. As an outgrowth of these concerns, the Western Airborne Contaminants Assessment Project (WACAP) was initiated in 2002 to determine the risk from airborne contaminants to ecosystems and food webs in national parks of the U.S. The specific objectives that guided design and implementation of WACAP were the following: 1. Determine if contaminants were present in western national parks. 2. If contaminants were present, determine in what way and where they were accumulating (geographically and by elevation). 3. If contaminants were present, determine which ones posed an ecological threat. 4. Determine which indicators appeared to be the most useful for assessing contamination. 5. If contaminants were present, determine the source of the air masses most likely to have transported contaminants to the national park sites

BRCA1 genomic deletions are major founder mutations in Dutch breast cancer patients

To date, more than 300 distinct small deletions, insertions and point mutations, mostly leading to premature termination of translation, have been reported in the breast/ovarian-cancer susceptibility gene BRCA1. The elevated frequencies of some mutations in certain ethnic subpopulations are caused by founder effects, rather than by mutation hotspots. Here we report that the currently available mutation spectrum of BRCA1 has been biased by PCR-based mutation-screening methods, such as SSCP, the protein truncation test (PTT) and direct sequencing, using genomic DNA as template. Three large genomic deletions that are not detected by these approaches comprise 36% of all BRCA1 mutations found in Dutch breast-cancer families to date. A 510-bp Alu- mediated deletion comprising exon 22 was found in 8 of 170 breast-cancer families recruited for research purposes and in 6 of 49 probands referred to the Amsterdam Family Cancer Clinic for genetic counselling. In addition, a 3,835-bp Alu-mediated deletion encompassing exon 13 was detected in 6 of the 170 research families, while an deletion of approximately 14 kb was detected in a single family. Haplotype analyses indicated that each recurrent deletion had a single common ancestor

SCORE2-diabetes : 10-year cardiovascular risk estimation in type 2 diabetes in Europe

Aims To develop and validate a recalibrated prediction model (SCORE2-Diabetes) to estimate the 10-year risk of cardiovascular disease (CVD) in individuals with type 2 diabetes in Europe. Methods and results SCORE2-Diabetes was developed by extending SCORE2 algorithms using individual-participant data from four large-scale datasets comprising 229 460 participants (43 706 CVD events) with type 2 diabetes and without previous CVD. Sex-specific competing risk-adjusted models were used including conventional risk factors (i.e. age, smoking, systolic blood pressure, total, and HDL-cholesterol), as well as diabetes-related variables (i.e. age at diabetes diagnosis, glycated haemoglobin [HbA1c] and creatinine-based estimated glomerular filtration rate [eGFR]). Models were recalibrated to CVD incidence in four European risk regions. External validation included 217 036 further individuals (38 602 CVD events), and showed good discrimination, and improvement over SCORE2 (C-index change from 0.009 to 0.031). Regional calibration was satisfactory. SCORE2-Diabetes risk predictions varied several-fold, depending on individuals' levels of diabetes-related factors. For example, in the moderate-risk region, the estimated 10-year CVD risk was 11% for a 60-year-old man, non-smoker, with type 2 diabetes, average conventional risk factors, HbA1c of 50 mmol/mol, eGFR of 90 mL/min/1.73 m(2), and age at diabetes diagnosis of 60 years. By contrast, the estimated risk was 17% in a similar man, with HbA1c of 70 mmol/mol, eGFR of 60 mL/min/1.73 m(2), and age at diabetes diagnosis of 50 years. For a woman with the same characteristics, the risk was 8% and 13%, respectively. Conclusion SCORE2-Diabetes, a new algorithm developed, calibrated, and validated to predict 10-year risk of CVD in individuals with type 2 diabetes, enhances identification of individuals at higher risk of developing CVD across Europe